Demystifying Prior Authorizations: Putting power back in healthcare consumers’ hands
In the complex world of healthcare, one of the most frustrating hurdles for healthcare consumers can be the prior authorization (PA) process. Here’s how Prescryptive is bringing transparency to this often opaque process.
By: Prescryptive Health
What is prior authorization?
Prior authorization—also known as pre-authorization or pre-certification—is a process to determine if insurance will cover a prescribed procedure, service, or medication. Before certain treatments or prescription drugs are approved, a healthcare provider must obtain permission from the insurer, confirming that the proposed care is medically necessary.
This process is often required for Specialty medications, high-cost treatments, or services outside standard guidelines. Designed to control costs and ensure appropriate care, prior authorizations can also frustrate both patients and healthcare providers.
A painful process for consumers that can delay care
Studies show that patients often face significant barriers due to prior authorization requirements. According to a survey by the American Medical Association (AMA), 94% of physicians reported delays in care because of prior authorizations, and 33% said these delays have led to serious adverse events for patients. Patients frequently have no visibility into the process—when it begins, what’s being reviewed, or what comes next—leaving them in the dark while they wait for crucial treatment.
Moreover, the administrative burden isn’t just felt by clinicians. Patients often find themselves navigating a confusing maze involving doctors, insurers, and pharmacies, all without clear guidance. A Health Affairs study noted that the complexity and opacity of PA procedures can deter patients from following through with care altogether.
A transparent prior authorization process with Prescryptive
Prescryptive is addressing this long-standing issue with a new, consumer-first solution inside the myPrescryptive mobile experience. Designed with transparency at its core, myPrescryptive introduces a real-time prior authorization tracker — think of it like a “pizza tracker,” but for your prescription’s prior authorization. This feature allows users to monitor each stage of the process from submission to decision, complete with secure text message updates.
Unlike the traditional process, where patients might wait days for a paper letter in the mail, myPrescryptive delivers PA outcomes directly in the app, giving users immediate clarity. Whether approved or denied, patients receive actionable information right when they need it.
Bringing visibility and choice into the high-cost Specialty process
This innovation is particularly important as the cost of specialty drugs continues to rise—projected to grow by 13.3% in 2025 alone. Many of these high-cost therapies require prior authorizations, making a streamlined, understandable process more important than ever.
myPrescryptive also empowers users to:
- Compare prescription costs with and without insurance
- Manage medications in a digital medicine cabinet
- Support caregiving roles with shared access
- Navigate the platform in multiple languages
And for digital health developers, this PA feature is available as an API—extending transparency and control beyond just myPrescryptive users to the broader healthcare ecosystem.
Prescryptive: Rewriting the script
By giving consumers full visibility into the PA process, Prescryptive is helping rewrite the script for pharmacy benefits. It’s a step toward a more equitable, user-friendly healthcare experience—one where the patient is no longer left in the dark.
Ready to rewrite the script with us? Get in touch to learn more about our solutions that are transforming the drug industry so that everyone can afford their care.